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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 5 of 5. This is the beginning of the thread.
Posted by sjb on November 7, 2002, at 9:28:17
Hi Dr. Gershon,
I have atypical depression and do not understand AD poop-out.
I have tried over 25 different medications and combos and some have seemed like miracles, for a period of time. The good periods have lasted anywhere from a week to six months. Greatest help was from Prozac, Luvox, and Effexor/Topomax.
My binge eating decreased, I didn't cry as easily and my fatigue lifted and I had greater energy, and most importantly, hope, that yes indeed, I was part of the human race, no better nor no worse than anyone else.Then it just falls apart and I feel ugly, eat and gain weight and feel like a total loser. Increased dosages would not help, as it would just aggravate the side effects.
I am now dreading the holidays and the food, socializing that is inherent in them. Many times I long to run a way to a cabin in the woods where no one can see me and I could avoid the pressures of society and social events.
I am now taking Lexapro and just recently increased from 10mg to 20mg. 10 mg worked great at first but I'm slipping.
Thank You.
Posted by djmmm on November 7, 2002, at 11:08:56
In reply to Gershon, Dr. - Atypical, social anxiety, poop-out, posted by sjb on November 7, 2002, at 9:28:17
Have you tried a medication that doesnt primarily effect the serotonin system? for example, Wellbutrin, or a MAOI?
You may respond better to meds that effect the norepinephrine system. You say that Prozac, Luvox and effexor all worked...Prozac and Luvox happen to be the least selective of the SSRIs, meaning, they effect other neurotransmitter systems as well. Also, Effexor has a dose dependent effect on the norepinephrine system.
I went through every ssri and combo you could imagine before trying a MAOI, and now have no problems.
Have you considered that perhaps the "poop-out" you are experiencing my be due to excess serotonin...there is some research on this. This may explain why increasing the dose of your meds doesn't help...In this case, you may want to try adding something like Buspar instead of increasing the SSRI.
Posted by sjb on November 7, 2002, at 13:38:00
In reply to Re: Gershon, Dr. - Atypical, social anxiety, poop-out, posted by djmmm on November 7, 2002, at 11:08:56
Thanks for the input. Very interesting stuff to think about.
I have tried Parnate but it did not help. I was hesitant to try Nardil due to it's weight gain potential. (I was told that Parnate was more weight neutral than Nardil, although I thought my cravings for sweets increased).
I am fairly active (when I'm not in a meltown) and the Parnate made me really dizzy at the gym, getting up and down on the machines. It also gave me extreme insomnia but I would fall asleep in my office around 4pm. I was cold all the time. My reaction time was slowed, and oh yeah, it didn't help my depression!
I tried Buspar, and again, seem more fatigued by it. I thing there are some newer MAOIs but I'm really spooked to try them considering my history and the period of time needed for washout, combination warnings, etc.
Posted by Ed O`Flaherty on November 7, 2002, at 14:32:07
In reply to Gershon, Dr. - Atypical, social anxiety, poop-out, posted by sjb on November 7, 2002, at 9:28:17
Do you prescribe omega-3 fish oil ?
Posted by egershon on November 10, 2002, at 14:45:30
In reply to Gershon, Dr. - Atypical, social anxiety, poop-out, posted by sjb on November 7, 2002, at 9:28:17
The story of antidepressants working at first and then failing is not, unfortunately, unusual. I'm not aware of any satisfactory biological study of this. Of course, we are only considering adequate dosages and length of trial of each antidepressant.
However, I have had patients rotating among antidepressants every few months, or (alternatively) having interruptions of antidepressants for 3 or 4 days followed by resumption of the same antidepressant. Each of these strategies has been helpful in individual cases. One also could consider maintenance ECT in such cases.
This is the end of the thread.
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